Abstract
Plasma immunoreactive alpha-human atrial natriuretic peptide (ANP) was measured in six cirrhotic patients with massive refractory ascites, under strict metabolic conditions, while they were receiving a 20-meq sodium diet, both before and at two-hour intervals for eight hours following peritoneovenous shunting (PVS). The mean preoperative level of ANP was 75 ± 18 pg/ml, which was found to be significantly higher than the normal range for this laboratory (8 to 24 pg/ml) (p <0.05). This value was also significantly higher than the value of 21 ±5 pg/ml (p <0.05) obtained in six patients with cirrhosis but without ascites. Following shunt insertion, an immediate natriuresis and diuresis were observed in five of the six cirrhotic patients with refractory ascites. In these five, right atrial pressure and ANP rose immediately, followed by a rise in the level of urinary cyclic guanosine monophosphate. The sixth subject had a delayed rise in right atrial pressure, and correspondingly the rise in ANP, the diuresis, and natriuresis were delayed. The changes in ANP following PVS were positively correlated with changes in right atrial pressure (p <0.05), urinary cyclic guanosine monophosphate (p <0.05), urinary sodium excretion (p <0.05), and urine volume (p <0.01). These results suggest that ANP may be important in mediating the acute response to PVS.
| Original language | English |
|---|---|
| Pages (from-to) | 112-119 |
| Number of pages | 8 |
| Journal | American Journal of Medicine |
| Volume | 84 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1988 |
| Externally published | Yes |
Bibliographical note
Funding Information:From the Departments of Medicine and Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. This work was supported by a grant from the PSI Foundation and the Heart and Stroke Foundation of Ontario. Dr. Campbell is a fellow of the Medical Research Council of Canada and Dr. Skorecki is a scholar of the Canadian Heart Foundation. Requests for reprints should be addressed to Dr. Laurence M. Blendis, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada. Manuscript submitted June 11, 1987, and accepted in revised form October 2, 1987.
Funding
From the Departments of Medicine and Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. This work was supported by a grant from the PSI Foundation and the Heart and Stroke Foundation of Ontario. Dr. Campbell is a fellow of the Medical Research Council of Canada and Dr. Skorecki is a scholar of the Canadian Heart Foundation. Requests for reprints should be addressed to Dr. Laurence M. Blendis, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada. Manuscript submitted June 11, 1987, and accepted in revised form October 2, 1987.
| Funders | Funder number |
|---|---|
| Heart and Stroke Foundation of Canada | |
| Physicians' Services Incorporated Foundation |